Communication Processes, Technology, and Patient Safety in Ambulatory Oncology Settings The purpose of this study is to characterize clinician communication processes, communication technologies, and adverse patient events in a sample of ambulatory chemotherapy practices and to examine how these practices and technologies influence safe chemotherapy administration. Safe chemotherapy delivery requires effective communication among clinicians to identify and manage adverse events before potentially lethal complications ensue. We do not know the extent to which communication processes such as the use of face- to-face clinician interactions occur in chemotherapy practices. The use of communication technologies in ambulatory care may alter workflow causing increased interruptions, a known contributor to medication errors, and other unintended consequences such as order entry systems that facilitate medication error risks. Specific Aims: We seek to: (1) characterize clinician communication processes, communication technologies, and adverse patient events; (2) examine how variation in clinician communication processes and communication technologies affect chemotherapy delivery practice; and (3) assess barriers and facilitators to safe chemotherapy delivery. Design and Methods: This study will use a sequential mixed-methods design, beginning with a quantitative survey followed by a two-part qualitative phase. Survey results from Aim 1 will provide a detailed assessment of current communication processes and use of technologies, which we will correlate with rates of: 1) chemo- therapy treatments delayed on the day of planned treatment, 2) unplanned emergency department visit or admission for acute adverse events during chemotherapy administration, and 3) emergency department visits for chemotherapy-associated toxicity. In Aim 2 we will select a purposive sample of practices with the range of communication processes and technology identified in Aim 1. We will stratify practices equipped with adequate communication technologies but struggling with high adverse event rates, and practices that do not have a lot of technologies but still perform well. Through observation, clinician shadowing, and patient interviews, we shall explore how communication processes and technology influence the adverse patient events listed above. In Aim 3 we will disseminate data from Aims 1 and 2 to leaders and clinicians in practice sites who will identify facilitators and barriers to safe chemotherapy delivery, so we can develop practice-level interventions for future testing. As these barriers and facilitators will likely vary across clinic performance, we shall elicit barriers and facilitators from practices at varying levels of performance on our three adverse patient event measures. Significance: This study will highlight how variation in clinician communication processes and communication technologies either promote or hamper safe chemotherapy delivery. Our proposed study is one of the few to examine how care is delivered across diverse practices, helping us to inform efforts to organize delivery practices in ways that minimize risks to patients.